Permit CITY OF TIGARD ELECTRICAL PERMIT
' - COMMUNITY DEVELOPMENT Permit #: ELC2011 -00278
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/25/2011
Parcel: 2S103CA02600
Jurisdiction: Tigard
Site address: 11905 SW JAMES CT
Project: PEDERSEN Subdivision: TRAVPORT PARK Lot: 6
Project Description: (2) branch circuits for bedroom fire damage.
Contractor: SQUIRES ELECTRIC Owner: PEDERSEN, MARK E & JODI M
PO BOX 16851 11905 SW JAMES CT
PORTLAND, OR 97292 TIGARD, OR 97223
PHONE: 503 - 252 -1609 PHONE:
FAX: 503 - 253 -5831
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 05/25/2011 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 05/25/2011 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0090. You ma o..'n a copy of e rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
� 1
Issued By: �r`5.� f Permittee Signature: �i� = . % !
'0
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
05/24/2011 08:27 5032535831 SQUIRES ELECTRIC #7532 P.002/002
Electrical Permit Aj)plication , FOR OFFICE USE ONLY
City of Tigard Received . .
' CM
13125 SW Hall Blvd., Tigard, OR 97223 \ C \ A\ Date/By: / ././ :VA,
Other Permit: _ ./.
Phone: 503.7182439 Fax: 503,598: 'N .0 1 . \j "`"
T Ci..'kRD f t r t,,\) Milliffillell. Permit NQ.: -'--'' . . 1/ . 9:7;
It ; F , ' ..
Inspection Line: 503,639.4175 \;-'' '••• \ v , " essvit, „c Dam ReadY/SY: kris: gl See Paee 2 for
I
Interact: www.tigard-or.gov x ' 1 w ( 'h ' 4tatificci/Method: ...-, Supplemental Information
_
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',,,k,,;;, leil.taitil!6pnlig, ; ' 14 c, ,V,VM.VA ff , $ . .F . ,I:03 "'ill '..'.;=.'' 03
)4 . villead'' '''., dar • , L.: '■'''s . AR''./AF4 , ' , ...alrlii.Tikti - .1,i . A ; ,e - -: . ; 7,, 4,,,,, ,k ,, , , -.12.. . .ka„ , j,,,.. , ,.. E ., : , .s.... ,,,, ,,,,,, ., 1,
0 New construction e Additionfaiterationirco.cev • - Please chock all that apply (submit Z sots of plans w/items checked below).
• \S' 1:1 serv,et or feeder 400 amps or more ['Building over three stories.
0 Demolition El Other:
where the available fault current 0 Marinas and boatyards.
. ?, ,' ,,.• ; :,,,Ner'shp';‘: ''.•''• ' " ,;',,,, ,. ;'p V ..,,g14 ...cds 10,000 maps at 150 volts or El Floating buildinss
,.. , i:,A, .: 0, N .',U117,,,,,i •'1 , ;"1 , ; ' ' , 0. 4 ' ''r ' '' I ' " "Ait ' aiik•e 4 •;:iThW.Mt$11) '/'''. '64Sec, ' :';'":'' M'''''' WI 1055 to ground, or excetds 14,000 0 Commercial- agri cul 1
E I - and 2 dwelling 0 Commercial/industrial 0 Accessory budding amps for alt other installations, buildings.
0 Multi 0 Master builder p Other: 0 Fire pump. El Installation of 75 KVA or
s•';'.!..'....i.VM,,k•f•:-:naiti',,I,']•'4;i:TIA'',,gai,-.6m::=::.'i,.i,T...'"1..ar.':7 '':' i'1, .,,15.r)°Jabf ,Ipp,s1 171 EmeTtcY sY'eTn. Iarser separately derived system
i .
.5% ,..,,, „.t; , ,,., .e , Iv „ieiltdS mid ,-'., u Addition of new motor load of 0 "A - E", "1-2", °I -3",
100HP or more. occupancy.
Job no.: lob site address: • ! 0 A
. i q-Acie---,2 e- i • 0 Six or more residential units. 0 Recreational vehicle parks.
City/State/Z17 ir , ii , / .1 ID Health-care facilities, 0 Supply voltage for more than
• 0
Hazardous locations. 600 volts nominal.
Suite/bldg./apt no.: ..' - Project name: 8 AiUMMII I:1 Service or feeder 600 amps or more.
[Trilge,T77,...17979.7:117.77497S, 4+ '
Cross street/directions to job site: la - k ..,,,,,Id., -'. ,, .+..,.,-,,..,•! * -*, , '..:
Demri..on _Sky. I Fee_ Total
— —. New residential single- or multi-fimily dwelling unit.
_____ Includes attached urage.
, .
Subdivision: 1 Lot no,: 1,000 sq. it. or less 1.11 168.54 MI
- Ea. addl 500 sq. ft. or portion 111.111ESSI mull
Tax map/parcel no,: -
Limited energy, residential
III 75,00
III
1 !:r . 'W• ''''''?'''4"3r.1■1":'.E. NatalittKiP•f:7i1..4,'IMRWr'77.11AVISlf:. tiMidaigill (with above 5.. ft.
Limited energy, multi-fmily II
11
75.00
l'€- be com a; c_ — b ^CTN • residential with shove -.. El.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 MB
glir ::•*. .7,41,i ', 201 amps to 400 amps ' 133.56
401 amps to 600 amps IM 200,34 _LEI
Name:
_ 601 amps to 1,000 amps III 501.04 Ell
Address:
Over 1.000 amps or volt 552.26 13
Temporary services or feeders installation, alteration, and/or
City/State/ZIP:
relocation
. Phone: ( ) Fax: ( ) 200 amps or less 59,36 I
201 amps to 400 •
Owner instillation: This installation is being made on property that I own which is not amps I 25.05
401 *amps to 599 168.54 11
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. atnps
Branch circuits - new, alteration, or extension 1 er panel
Owner signature: Date: A. Fee for branch circuits with
—
i above service Or feeder fee,
t1/471ghiala Ali•;l4L,,'!:' . ;1.044' . • 1 r , Fal i te ,. at, ■i Vi NA3MET1
.....lie... ' Ad, ,''' `'aiL.:4 . " ' 0 '"' each branch circuit 742 2
Business name: B. Pee for branch circuits without
— service or feeder fcc, first
.
5O.I8 . gl
branch circuit
Contact name'
Each add'l branch circuit Rim 7.42 IMM
Address:
Miscellaneous (service or feeder not included
Each manufactured or modular
City/State/ZIP:
dwelling, service and/or feeder 67.84 2
Phone: ( ) I FaX ! ( ) Reconnect only 67.84
il: El
Pump or irrigation circle Ill 67.84 El
E-ma
,
, Sign or outline lighting 67.84
ii r•• V7.C.G:, i i,c"'", , ,• si [ r , ,,,,,,p. 1,1,,,,,,,.0 IN --, ,,,■,,,,,, .... ..,. .. , .
!.M Ali .. , 11, ',,,i, .PL,... ' .,',.P , t ; ■i„I „., Signal
circuits) or limited-energy
e
• ; el, alteration or extension. Page 2
Business name: 9 tia 1 ...
• ...1- 1 L. ,,
Each additional inspection over allowable in any of the above
—
Address: i,e) E) 0 E --- i (,) a co. /0...0,._ Q.644 04-1 Additional inspecriOn (l hr min) 66,25/ hr
Investigation (I hr min) 66.25/ hr
City/State/ZIP: fz _ 4 ,: - \ , - , De_ ?
,.- 1 Industrial plant (1 hr min) 78,18/ lit
Phone; zs l 'S , f4 0 Pax: .(6Z>3) c „1.5 - 3 .......6 / . Inspections for which no fee is
90,00/ hr
S• cificall listed K hr min)
CC13 Lie,: 05 Electrical Lie01-116i Suprv. Lic.: 4 eg1 mi wgpigltax4 ..
_
Subtotal 1.
,,5,/,
Suprv. Electrician signature, requir
''.--
- Plan review (25% of permit fee);
Date;
State surcharge (12% of permit fee):
Print name: t z...16E . ,,..6 t
„ u r ),...t.,,3 8-Aff/ • tP Z
TOTAL PERMIT FEE: ri 1 , az
Authorized signature:
This permit application expires if a permit Is not o b„,i w i t hi n 180
days after it has been accepted as complete,
Print name: .. Date:
• Number of inspections allowed per permit
I:\BuildinPernin\ELC-PermitApp4oc M/01/10 440-45151'K] I/OS/COM/WEB